Covered Entity Details

DSH160064AB MercyOne North Iowa Medical Center (Terminated) - information as of 5/13/2025 11:03:14 PM

Main Details

Name

MercyOne North Iowa Medical Center

Subdivision Name

MERCYONE NORTH IOWA NEUROSURGERY CARE

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH160064AB

Medicare Provider Number

160064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/11/2019

Participating Start Date

10/1/2019

Participating Approval Date

7/29/2019

Last Recertification Date

8/19/2024

Termination Date
Termination Reason

1/1/2025
DSH percentage below statutory minimum

Contacts

Authorizing Official

MercyOne North Iowa Medical Center
Mark Trammel, HM VP Finance
(641) 428-7984

Primary Contact

MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024

Addresses

Street Address

1010 4TH ST SW
STE 105
MASON CITY, IA 50401-2857

Billing Address

MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH160064A	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Family Medicine Residency	1010 Fourth Street SW	Mason City	IA	Terminated
DSH160064AA	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Medication Management - Anticoagulation Clinic	621 S ILLINOIS AVE	MASON CITY	IA	Terminated
DSH160064AB	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA NEUROSURGERY CARE	1010 4TH ST SW	MASON CITY	IA	Terminated
DSH160064AC	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA PODIATRY - PODIATRY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AD	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA PSYCHIATRY - PSYCHIATRY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AE	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA ORTHOPEDICS - ORTHOPEDICS	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AF	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA GENERAL SURGERY - SURGERY	250 S CRESCENT DRIVE	MASON CITY	IA	Terminated
DSH160064AG	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA EARS, NOSE & TH - EARS, NOSE, THROAT & ALLERGY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AH	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA INTERVENTIONAL - INTERVENTIONAL PAIN MANAGEMENT	250 S CRESCENT DRIVE	MASON CITY	IA	Terminated
DSH160064AJ	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA PLASTICS & RECO - PLASTICS & RECONSTRUCTIVE SURGERY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AK	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA NEUROLOGY - NEUROLOGY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AL	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA UROLOGY - UROLOGY	250 S CRESCENT DR	MASON CITY	IA	Terminated
DSH160064AM	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA GASTROENTEROLOG - GASTROENTEROLOGY	250 S CRESCENT DRIVE	MASON CITY	IA	Terminated
DSH160064AN	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA ALLERGY & IMMUN - Allergy & Immunology	250 S CRESCENT DRIVE	MASON CITY	IA	Terminated
DSH160064AP	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA PEDIATRIC NEURO - MercyOne North Iowa Pediatric Neurology Care	910 N EISENHOWER AVE	MASON CITY	IA	Terminated
DSH160064AQ	Child	DSH	MercyOne North Iowa Medical Center	MERCYONE NORTH IOWA INTERNAL MEDICI - MercyOne North Iowa Internal Medicine Residency	1010 4TH ST SW	MASON CITY	IA	Terminated
DSH160064AR	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Integrative Medicine - Family & Sports Medicine	910 N Eisenhower Ave	Mason City	IA	Terminated
DSH160064AS	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Rheumatology Care - Rheumatology Care	910 N Eisenhower Ave	Mason City	IA	Terminated
DSH160064AT	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Women’s Health Care and Internal Medicine - Internal Medicine - Internal Medicine Clinic	1631 Fourth Street SW	Mason City	IA	Terminated
DSH160064B	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Women’s Health Care and Internal Medicine - Women's Health Care	1631 Fourth Street SW	Mason City	IA	Terminated
DSH160064C	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Mason City Urgent Care	1631 Fourth Street SW	Mason City	IA	Terminated
DSH160064D	Child	DSH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Dialysis Center - Charles City	707 Gilbert Street	Mason City	IA	Terminated
DSH160064E	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Center for Diabetes, Endocrinology, Kidney and Weight Loss - Kidney Center	910 N Eisenhower Ave	Mason City	IA	Terminated
DSH160064F	Child	DSH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Dialysis Center - Mason City	910 N Eisenhower Avenue	Mason City	IA	Terminated
DSH160064G	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Heart Center	250 S Crescent Drive	Mason City	IA	Terminated
DSH160064H	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Sheffield Family Medicine	203 S Second Street	Sheffield	IA	Terminated
DSH160064J	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Lake Mills Family Medicine	505 S First Avenue E	Lake Mills	IA	Terminated
DSH160064K	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Diabetes Center	910 N EISENHOWER AVENUE	MASON CITY	IA	Terminated
DSH160064L	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Obstetrics and Gynecology	1010 Fourth Street SW	Mason City	IA	Terminated
DSH160064M	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Greene Family Medicine	104 E Traer Street	Greene	IA	Terminated
DSH160064N	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Physical Medicine and Rehabilitation	910 N EISENHOWER AVE	MASON CITY	IA	Terminated
DSH160064P	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Forest Park Family Medicine	1010 Fourth Street SW	Mason City	IA	Terminated
DSH160064Q	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Clear Lake Pediatric & Adolescent Care	401 S Fifteenth Street	Clear Lake	IA	Terminated
DSH160064R	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Northwood Family Medicine	803 Ninth Avenue N	Northwood	IA	Terminated
DSH160064S	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Mason City Pediatric & Adolescent Care	910 N EISENHOWER AVE	MASON CITY	IA	Terminated
DSH160064T	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Clear Lake Family Medicine	1410 Sixth Avenue S	Clear Lake	IA	Terminated
DSH160064U	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Rockford Family Medicine	702 E Main Avenue	Rockford	IA	Terminated
DSH160064V	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Forest City Family Medicine	635 E Highway 9	Forest City	IA	Terminated
DSH160064W	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Regency Family Medicine	621 S Illinois Avenue	Mason City	IA	Terminated
DSH160064X	Child	DSH	MercyOne North Iowa Medical Center	MercyOne North Iowa Dermatology Care	1421 Fourth Street SW	Mason City	IA	Terminated
DSH160064Z	Child	DSH	MercyOne North Iowa Medical Center	MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Bariatric Center	910 N Eisenhower Ave	Mason City	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/25/2024 12:00:00 AM	12/2/2024 7:53 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/2/2024 7:53 AM
Terminations	Termination Comments	Update	Termination Request		MercyOne NI Medical Center will be registering as SCH (DSH % 9.36) on 1/1/25 with a start date of 4/1/25.	12/2/2024 7:53 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/2/2024 7:53 AM
Terminations	Termination Effective Date	Update	Termination Request		11/26/2024 12:00:00 AM	12/2/2024 7:53 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/2/2024 7:53 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 11:23:08 AM	8/19/2024 1:43:50 PM	8/19/2024 1:43 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 5:54:26 PM	9/5/2023 11:23:08 AM	9/5/2023 11:23 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 2:24:26 PM	9/13/2022 5:54:26 PM	9/13/2022 5:54 PM
Contacts	Authorizing Official	Update	Change Request	Fischels, Diane RHM COO MercyOne North Iowa Medical Center 6414287362	Trammel, Mark HM VP Finance MercyOne North Iowa Medical Center 6414287984	5/31/2022 12:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Brownmiller, Erin 340B Program Supervisor MercyOne North Iowa Medical Center 6414287024	Brownmiller, Erin 340B Program Manager MercyOne North Iowa Medical Center 6414287024	10/13/2021 11:18 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 11:32:44 AM	9/10/2021 2:24:26 PM	9/10/2021 2:24 PM
Contacts	Authorizing Official	Update	Change Request	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	Fischels, Diane RHM COO MercyOne North Iowa Medical Center 6414287362	2/4/2021 12:31 PM
Details	Last Recertification Date	Update	Recertification		9/10/2020 11:32:44 AM	9/10/2020 11:32 AM
Contacts	Primary Contact	Update	Profile Change Request	Brownmiller, Erin 340B Program Coordinator MercyOne North Iowa Medical Center 6414287024	Brownmiller, Erin 340B Program Supervisor MercyOne North Iowa Medical Center 6414287024	1/13/2020 3:33 PM
Details	Entity Subname	Update	Change Request	MERCYONE NORTH IOWA NEUROSURGERY CA - Neurosurgery	MERCYONE NORTH IOWA NEUROSURGERY CARE	11/7/2019 1:11 PM
Details	Entity Name	Update	Change Request	MERCY MEDICAL CENTER - MASON CITY	MercyOne North Iowa Medical Center	11/7/2019 1:01 PM
Contacts	Authorizing Official	Update	Profile Change Request	ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	10/15/2019 1:05 PM
Contacts	Signed By	Update	Profile Change Request	ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	10/15/2019 1:05 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Addresses	Billing Address	Insert	New Registration		MercyOne North Iowa Medical Center 1000 4th Street SW Mason City, IA 50401	7/29/2019 9:48 AM
Contacts	Signed By	Insert	New Registration		ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	7/29/2019 9:48 AM
Details	340B ID	Update	New Registration		DSH160064AB	7/29/2019 9:48 AM
Details	Entity Subname	Update	New Registration	MERCYONE NORTH IOWA NEUROSURGERY CA	MERCYONE NORTH IOWA NEUROSURGERY CA - Neurosurgery	7/29/2019 9:48 AM
Dates	Participating Approval Date	Update	New Registration		7/29/2019 9:48:40 AM	7/29/2019 9:48 AM
Details	State	Update	New Registration	Pending	Approved	7/29/2019 9:48 AM
Dates	Signed By Date	Update	New Registration		7/11/2019 3:19:01 PM	7/29/2019 9:48 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	7/29/2019 9:48 AM
Addresses	Main Address	Insert	New Registration		1010 4TH ST SW STE 105 MASON CITY, IA 50401-2857	7/11/2019 1:04 PM
Addresses	Billing Address	Insert	New Registration		MercyOne North Iowa Medical Center 1000 4th Street SW Mason City, IA 50401	7/11/2019 1:04 PM
Addresses	Shipping Address	Insert	New Registration		MercyOne North Iowa Medical Center 1000 4th Street SW Mason City, IA 50401	7/11/2019 1:04 PM
Contacts	Primary Contact	Insert	New Registration		Brownmiller, Erin 340B Program Coordinator MercyOne North Iowa Medical Center 6414287024	7/11/2019 1:04 PM
Contacts	Authorizing Official	Insert	New Registration		ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	7/11/2019 1:04 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2019 1:04 PM
Details	Grant Number	Insert	New Registration			7/11/2019 1:04 PM
Details	340B ID	Insert	New Registration			7/11/2019 1:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2019 1:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2019 1:04 PM
Details	Medicare Provider Number	Insert	New Registration		160064	7/11/2019 1:04 PM
Details	Entity Name	Insert	New Registration		MERCY MEDICAL CENTER - MASON CITY	7/11/2019 1:04 PM
Details	Program Code	Insert	New Registration		DSH	7/11/2019 1:04 PM
Details	Entity Subname	Insert	New Registration		MERCYONE NORTH IOWA NEUROSURGERY CA	7/11/2019 1:04 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2019 1:04 PM
Details	State	Insert	New Registration		Pending	7/11/2019 1:04 PM
Dates	Registration Date	Insert	New Registration		7/11/2019 1:04:30 PM	7/11/2019 1:04 PM
Dates	Signed By Date	Insert	New Registration			7/11/2019 1:04 PM
Dates	Start Date	Insert	New Registration			7/11/2019 1:04 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2019 1:04 PM
Terminations	Termination Date	Insert	New Registration			7/11/2019 1:04 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2019 1:04 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2019 1:04 PM